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Background: Retroperitoneal exposure of the anterior spine, (ALIF), has become an increasingly necessary intervention for the vascular surgeon. Because of the major vascular and neurological structures encountered, the procedure can be arduous and challenging. This review was performed to retrospectively evaluate our results.
Methods: Two hundred and seventy three cases of exposures for ALIF were performed. .A modified bowel prep was utilized one day before operation. A vascular exam was done after closure of the retroperitoneum. Two hundred and sixty six cases, (97.5%), were open exposures. Seven cases, (2.5%), were laparoscopic, transperitoneal exposures.Exposure was limited in one case by a Left sided Vena Cava. In one instance, a complete Situs Inversus necessitated exposure of from the right retroperitoneum.
Results: Two hundred and fifty six cases, (93.1%), were performd uneventfully.Ninteen complications, (6.9%) were encountered. Complications were classified as major,(7), and Minor, (12). Mortality was 0.3%.Two major venous bleeding were encountered, and 2 post operative hematoma were aspirated.Three patients had post operative pulse deficits. Prompt revascularization with 3 arterial, and 1 venous stent placement corrected all venous and arterial occlusion. Seroma/ Lymphocele, was by far the most commom complication, (2.5%), encountered.Ultrasound, or CT guided aspiration was successful in resolution of 5 seroma . Two hernias, and 2 instances of retrogreade ejaculation were noted.
Conclusion: Calcification of the vascular system on plain Xray examination is a good indicator of intrinsic vascular disease. Care should be taken to avoid venous anomalies. Preservation of the sympathetic chain, at L1-L2, may prevent retrograde ejaculation. Herniation after retroperitoneal exposure are diffcult to repair. Exposure for ALIF can be performed with low mortality and morbidity through attention to care and thorough pre and post op evaluation.